Regulatory Compliance Policy No. COMP-RCC 4.11 Title:

Size: px
Start display at page:

Download "Regulatory Compliance Policy No. COMP-RCC 4.11 Title:"

Transcription

1 I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.11 Title: Page: 1 of 7 INPATIENT REHABILITATION FACILITY ADMISSION, CONTINUED STAY, AND DISCHARGE CRITERIA Effective Date: Retires Policy Dated: Previous Versions Dated: ; This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other entity or organization in which an Affiliate owns a direct or indirect equity interest greater than 50%; and (3) any hospital or healthcare facility (each, a Tenet Facility ) that provides Acute Inpatient Rehabilitation Facility services and an Affiliate either manages or controls the day-to-day operations of the facility (each, a Tenet Inpatient Rehabilitation Facility or Tenet IRF ); (collectively, Tenet ). II. PURPOSE: The purposes of this policy are to ensure that patients are admitted to Tenet s IRFs based on appropriate admission criteria and that all care provided in the IRF is reasonable and necessary as it applies to decisions for admission, continued stay and determination of the timing for discharge. III. DEFINITIONS: A. Federal health care program means any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government, including, but not limited to, Medicare, Medicaid/MediCal, managed Medicare/Medicaid/MediCal, TriCare/VA/CHAMPUS, SCHIP, Federal Employees Health Benefit Plan, Indian Health Services, Health Services for Peace Corp Volunteers, Railroad Retirement Benefits, Black Lung Program, Services Provided to Federal Prisoners, Preexisting Condition Insurance Plans (PCIPs) and Section 1011 Requests. B. Inpatient Rehabilitation Facility Program Director or IRF Program Director means the individual employed by the Tenet Facility to manage the IRF unit. C. Managed Care Payer means, for the purposes of this policy, any contracted third party payor who pays, or is expected to pay, benefits to the Facility under a health insurance policy. Although not typically included as a Managed Care Payer in Tenet policies, for purposes of this policy, Managed Care Payer includes managed Federal health care programs (e.g., managed Medicare and managed Medicaid). Managed Care Payer does not include any other Federal healthcare program. IV. POLICY: All inpatient rehabilitation services provided in a Tenet IRF shall meet the appropriate medical necessity criteria and all care provided in the IRF shall be reasonable and necessary as it applies to decisions for admission, continued stay and determination of the timing for discharge.

2 V. PROCEDURE: Regulatory Compliance Policy No. COMP-RCC 4.11 Title: Page: 2 of 7 INPATIENT REHABILITATION FACILITY ADMISSION, CONTINUED STAY, AND DISCHARGE CRITERIA A. Admission Criteria Effective Date: Retires Policy Dated: Previous Versions Dated: ; Patients must meet the stated criteria to be admitted to Tenet IRF. All inpatient rehabilitation services provided in a Tenet IRF shall meet the appropriate medical necessity criteria as set forth in this policy. For patients who are covered by any payer other than traditional Medicare (e.g., a Managed Care Payer, other non-medicare Federal healthcare programs, etc.) the IRF Program Director is responsible for ensuring that the IRF adheres to all of the applicable non-medicare payer s requirements including without limitation, preauthorization or pre-certification requirements, coverage criteria and billing requirements. These requirements may be specified in a Managed Care Agreement, program manuals for non-medicare Federal health care program payers and other written or verbal instructions from the payer. The IRF Program Director is responsible for understanding those requirements and ensuring the adherence to these requirements by the IRF. In addition, those who submit claims to the payer on behalf of the IRF (e.g. Conifer) shall also ensure that they understand the requirements so the billing for care is accurate. Program management and billing personnel are expected to confer during the course of the patient s stay as a means to ensure that billing is accurate. Tenet IRF programs shall comply with all documentation requirements described in Attachment A. 1. The patient must have significant functional deficits, as well as documented medical and nursing needs, regardless of diagnosis, that require: a. Close medical supervision by a physiatrist or other physician qualified by training and experience in rehabilitation. b. 24-hour availability of nurses skilled in rehabilitation; and c. Treatment by multiple other licensed rehabilitation professionals (such as physical therapists, occupational therapists, speech language pathologists, and prosthetics/orthotics) as needed in a time-intensive and medically-coordinated program.

3 Regulatory Compliance Policy No. COMP-RCC 4.11 Title: Page: 3 of 7 INPATIENT REHABILITATION FACILITY ADMISSION, CONTINUED STAY, AND DISCHARGE CRITERIA Effective Date: Retires Policy Dated: Previous Versions Dated: ; The medical stability of the patient and management of medical or surgical co-morbidities are considered to be: a. Manageable in the rehabilitation program; and b. Permit simultaneous participation in the rehabilitation program. 3. The patient presents as capable of fully participating in the inpatient rehabilitation program as evidenced by: a. A mental status demonstrating responsiveness to verbal, visual, and/or tactile stimuli and ability to follow simple commands. b. An ability to actively participate in an intensive level of rehabilitation (generally defined as 3 hours of therapy per day five days per week). 4. The patient has objective and measurable functional goals identified to warrant the admission that: a. Offer practical improvements; and b. Are expected to be achieved within a reasonable period of time 5. The patient has a reasonable probability of benefiting from the inpatient rehabilitation program. 6. The patient, in most circumstances, has a home and available family or care providers such that there is a likelihood of returning the patient to home or a community-based environment. While Tenet sets forth the criteria for admission for its IRF programs, it does so to comply with regulatory requirements. Medical Directors and other personnel are accountable for documenting justification for the admission within the medical record. The Medical Director or other admitting rehab physicians are supported but held accountable to make the final decisions for admission to the IRF programs. It is therefore incumbent upon them to detail the level of functional and medical severity that supports the admission and the decision to care for the patient in the IRF setting.

4 Regulatory Compliance Policy No. COMP-RCC 4.11 Title: Page: 4 of 7 INPATIENT REHABILITATION FACILITY ADMISSION, CONTINUED STAY, AND DISCHARGE CRITERIA B. Exclusions to Admission Effective Date: Retires Policy Dated: Previous Versions Dated: ; The following medical conditions are excluded from IRF admission: a. Ventilator dependent patients; b. Presence of an untreated psychiatric disorder as a primary diagnosis or on suicidal precautions and/or unstable psychiatric condition; c. Profound anemia with declining Hemoglobin/Hematocrit of unknown etiology; d. Patients with chest tubes; e. Active TB or any other respiratory infection requiring respiratory isolation; f. Patients with a Rancho Los Amigos Head Injury scale score 1 3; and g. Patients on cardiac medication drips (e.g., dopamine). 2. The following medical conditions may be admitted upon Medical Director approval with an established plan of care that is evidenced in the History and Physical. a. Patients with a terminal illness and a prognosis less than six months; b. Patients with MRSA, VRE, C-Diff and other infections requiring contact isolation; c. Individuals requiring telemetry, if telemetry is available in the IRF; d. Patients on neutropenic precautions WBC <4.0; e. Patients with a Rancho Los Amigos Head Injury scale score 4; f. Patients requiring radiation and/or chemotherapy; g. Spinal cord injury patients with strength less than 2/5 that are not receiving low molecular weight heparin or have not had placement of a venous filter catheter; and

5 Regulatory Compliance Policy No. COMP-RCC 4.11 Title: Page: 5 of 7 INPATIENT REHABILITATION FACILITY ADMISSION, CONTINUED STAY, AND DISCHARGE CRITERIA Effective Date: Retires Policy Dated: Previous Versions Dated: ; h. Patients under 18 years of age. The Medical Director may make admitting decisions on other cases not listed here provided that the physician determines that the patient care requirements are within the experience level of the treatment team, the needed resources can be obtained, and there is an established plan of care as evidenced in the History and Physical. C. Continued Stay Criteria Acute inpatient rehabilitation requires evidence of an interdisciplinary, coordinated rehabilitation team review at least once weekly, which should document ALL of the following: 1. Evidence of active participation in a multi-disciplinary rehabilitation program; AND 2. Evidence of progress toward stated goals documented by objective functional measures; AND 3. Identification of range and severity of the individual s problems, including medical status and stability, self-care, mobility, psychological status, and communication status ; AND 4. Consideration of special equipment needs when appropriate; AND 5. Goal modification based on current status, progress, and potential for improvement; AND 6. Projected length of stay and discharge/disposition planning; AND 7. Status of training provided to the patient and family members/caregivers by various rehabilitation disciplines regarding post discharge care; AND 8. Identification of barriers to progress, including any medical complications likely to impede progress; AND 9. Information regarding the status of the underlying medical condition In general, the documentation should provide evidence that the individual is benefiting from the program, that there is progress towards reasonable goals, and that acute inpatient rehabilitation continues to be the most appropriate level of care.

6 Regulatory Compliance Policy No. COMP-RCC 4.11 Title: Page: 6 of 7 INPATIENT REHABILITATION FACILITY ADMISSION, CONTINUED STAY, AND DISCHARGE CRITERIA D. Discharge Criteria Effective Date: Retires Policy Dated: Previous Versions Dated: ; Discharge from acute inpatient rehabilitation is appropriate if one or more of the following is present. 1. Treatment goals necessitating the inpatient setting were achieved; OR 2. Absence of participation in an interdisciplinary rehabilitation program; OR 3. The individual has limited potential for recovery (e.g. the individual s functional status has remained unchanged or additional functional improvement appears unlikely within a reasonable time frame; OR 4. Individual is unable to actively participate in an intensive rehabilitation program (most typically defined as at least 3 hours of multidiscipline therapy per day, at least 5 days per week): OR 5. The overall medical status is such that no further progress is anticipated or only minimal gains that could be expected to be attained with either less intensive therapy or regular daily activities. E. Responsible Person The IRF Program Director is responsible for ensuring that all professional level rehabilitation personnel inclusive of the Medical Director adhere to the requirements of this policy. If the IRF Program Director is unable to create adherence to this policy, the IRF Program Director shall immediately report the non-adherence to this policy to the Hospital Compliance Officer. F. Auditing and Monitoring Tenet s Audit Services Department shall monitor adherence to this policy during its full scope audits. G. Enforcement All employees whose responsibilities are affected by this policy are expected to be familiar with the basic procedures and responsibilities created by this policy. Those employees who fail to comply with this policy will be subject to appropriate performance management pursuant to all applicable policies and procedures, up to and including termination. Such performance improvement may also include modification of compensation, including any merit or discretionary compensation awards, as allowed by applicable law.

7 Regulatory Compliance Policy No. COMP-RCC 4.11 Title: Page: 7 of 7 INPATIENT REHABILITATION FACILITY ADMISSION, CONTINUED STAY, AND DISCHARGE CRITERIA Effective Date: Retires Policy Dated: Previous Versions Dated: ; VI. REFERENCES: - Regulatory Compliance Policy COMP-RCC-4.18, Clinical Determination of Appropriate Patient Status - Medicare Benefit Policy Manual, Ch Inpatient Hospital Services Covered Under Part A Inpatient Rehabilitation Services - 42 CFR (b) - 42 CFR (a)(2) - 42 CFR CFR (a)(3)-(5) - Quality, Compliance and Ethics Program Charter - Standards for Assessing Medical Appropriateness Criteria for Admitting Patients to Rehabilitation Hospitals or Units, AMRPA VII. ATTACHMENTS: - Attachment A: Inpatient Rehabilitation Documentation and Billing Requirements

8 Page 1 of 11 INPATIENT REHABILITATION DOCUMENTATION AND BILLING REQUIREMENTS I. Medicare Coverage Criteria: IRF care is only considered by Medicare to be reasonable and necessary if, as documented in the patient s medical record, the patient meets the following criteria at the time of the patient s admission to the IRF: A. Multiple Therapy Disciplines At the time of admission to the IRF, there shall be a reasonable expectation that the patient requires the active and ongoing therapeutic intervention of multiple therapy disciplines (physical therapy, occupational therapy, speechlanguage pathology, or prosthetics/orthotics). One of the therapy disciplines shall be physical or occupational therapy. B. Intensive level of Rehabilitation Services At the time of admission to the IRF, there shall be a reasonable expectation that the patient requires the intensive rehabilitative therapy services that are uniquely provided in an IRF. 1. Three Hour Rule --The generally-accepted standard by which the intensity of services is demonstrated in IRFs is by the provision of intensive therapies at least 3 hours per day at least 5 days per week. In certain well-documented cases, an intensive rehabilitation therapy program might instead consist of at least 15 hours of intensive rehabilitation therapy within a 7 consecutive day period, beginning with the date of admission to the IRF, as long as the reasons for the patient s need for this program of intensive rehabilitation are well-documented in the patient s medical record and the overall amount of therapy can reasonably be expected to benefit the patient. In any case, the intensity of therapy shall be reasonable and necessary and shall never exceed the patient s level of need or tolerance, or compromise the patient s safety. 2. Start of Therapy--The required therapy treatments shall begin within 36 hours from midnight of the day of admission to the IRF. Therapy evaluations constitute the beginning of the required therapy services and may also be included in the total provision of therapies used to demonstrate the intensity of therapy service provided in an IRF. 3. Individualized Therapy--The standard of care for IRF patients is individualized (i.e. oneto-one) therapy. Group therapies serve only as an adjunct to individual therapies and may not be counted toward the requirement that patients receive at least 3 hours of intensive therapy at least 5 days per week. Group therapy is defined as either (1) a group of patients doing the same treatment with the same plan and goals or (2) overlapping treatment time of more than one patient to one therapist. In those instances in which group therapy is used on a limited basis, the rationale that justifies group therapy shall be specified in the patient s medical record at the IRF. 4 Brief Exception Policy--If an unexpected clinical event occurs during the course of the patient s IRF stay that limits the patient s ability to participate in the therapy program for a brief period not to exceed 3 consecutive days (e.g. extensive diagnostic tests off

9 Page 2 of 11 premises, prolonged intravenous infusions of chemotherapy or blood products, bed rest due to signs of deep vein thrombosis, surgical procedure, etc) the specific reasons shall be documented in the patient s medical record. If these reasons are appropriately documented in the medical record, such a limited break in service will not affect the determination of medical necessity of the IRF admission. C. Ability to Actively Participate in Intensive Rehabilitation Therapy at the time of admission to the IRF, there shall be a reasonable expectation that the patient can actively participate in, and significantly benefit from, the intensive rehabilitation therapy program. The information in the preadmission screening, the post-admission physician evaluation, the overall plan of care, and the admission orders shall clearly document this expectation. 1. Significant Benefit/Measurable Practical Improvement--a patient can only be expected to benefit significantly from an intensive rehabilitation therapy program provided in the IRF if the patient s medical record indicates a reasonable expectation that a measurable, practical improvement in the patient s functional condition can be accomplished within a predetermined and reasonable period of time. The patient s medical record shall document both the nature and degree of expected improvement and the expected length of time to achieve the improvement. 2. Functional Improvement--the IRF medical record shall also demonstrate that the patient is making functional improvements that are ongoing and sustainable, as well as of practical value, measured against his/her condition at the start of treatment. The patient s treatment goals and achievements during an IRF admission are expected to reflect significant and timely progress toward the end goal of returning to the home or community-based environment. 3. Discharge Planning--discharge planning is an integral part of any rehabilitation program and shall begin upon the patient s admission to the IRF. An extended period of time for discharge from the IRF would not be reasonable and necessary after established goals have been reached or the determination has been made that further progress is unlikely. D. Physician Supervision at the time of admission to the IRF, there shall be a reasonable expectation that the patient s medical management and rehabilitation needs require an inpatient stay and close physician involvement. 1. Face-to-Face Visits--close physician involvement is demonstrated by documented faceto-face visits at least 3 days per week from a rehabilitation physician or other licensed treating physician with specialized training and experience in rehabilitation throughout the patient s stay in the IRF. The purpose of the face-to-face visits is to assess the patient both medically and functionally with an emphasis on the important interactions between the patient s medical and functional goals and progress, as well as to modify the course of treatment as needed to maximize the patient s capacity to benefit from the rehabilitation process. The required rehabilitation visits shall be documented in the patient s medical record.

10 Page 3 of Non-Rehabilitation Physicians--Other physician specialties may treat and visit the patient, as needed; however, these visits do not count toward the rehabilitation physician requirements described above. 3. Physician Progress Notes--physician progress notes shall be legible and include documentation of medical issues, consultant coordination and functional status. At a minimum the physician progress notes shall reflect active and ongoing rehab management and document: (a) Coordination of medical management as it impacts the rehabilitation process i.e.; coordination of consultant services and communication with referring and primary care physicians (b) Coordination of the rehabilitation team process (c) Participation in family conference (d) Participation in team conference (e) Revisions to the anticipated plan of care (f) Determination of impairment/functional status (g) Ongoing assessment of rehabilitation services (h) Assessment and/or management of the plan as it relates to the rehabilitation process (i) Assessment of discharge status and/or needs i.e.; follow-up E. Interdisciplinary Team Approach to the Delivery of Care--at the time of admission to the IRF, the patient shall require an intensive and coordinated interdisciplinary approach to providing rehabilitation. The documentation in the patient s medical record shall indicate that the complexity of the patient s nursing, medical management and rehabilitation needs require an inpatient stay and an interdisciplinary team approach to the delivery of rehabilitation care. 1. Required Disciplines--the interdisciplinary team shall document participation by professionals from the following disciplines (each of whom shall have current knowledge of the patient as documented in the medical record): (a) rehabilitation physician with specialized training and experience in rehabilitation services (b) a registered nurse with specialized training and experience in rehabilitation services (c) a social worker or a case manager (or both) (d) a licensed or certified therapist from each therapy discipline involved in treating the patient

11 Page 4 of Rehabilitation Physician--the interdisciplinary team shall be led by a rehabilitation physician who is responsible for making the final decisions regarding the patient s treatment in the IRF. This physician shall document concurrence with all decisions made by the interdisciplinary team at each meeting. A physician extender, NP or PA may participate in Team Conference; however, the requirement is not met if the physician is not present and participating in the team conference. 3. Team Conferences--the team conferences shall be held a minimum of once per week and focus on: (a) Assessing the individual s progress towards the rehabilitation goals. (b) Considering possible resolutions to any problem that could impede progress towards the goals. (c) Reassessing the validity of the rehabilitation goals previously established. (d) Monitoring and revising the treatment plan as needed. 4. All treating professionals from the required disciplines must attend every meeting or, in the infrequent case of an absence, be represented by another person of the same discipline who has current knowledge of the patient. 5. Documentation of each team conference shall include the names and professional designations of the participants in the team conference as demonstrated by the signature of each of the team members present at the team conference. 6. The occurrence of the team conference and the decisions made during the team conferences, such as those concerning discharge planning and the need for any adjustment in goals or in the prescribed treatment program, shall be recorded in the patient s medical record. II. Documentation and Claim Submission Requirements: For traditional Medicare beneficiaries, prior to billing a claim for services to Medicare, the IRF Director shall confirm that the medical record contains documentation that meets the coverage criteria established by the Medicare Benefit Policy Manual, Chapter 1, Section 110 and supported by regulatory changes found in 42 C.F.R. Section for inpatient rehabilitation services provided in inpatient rehabilitation facilities and all of the requirement of this policy. The IRF Program Director is responsible for establishing an oversight process at the IRF to ensure that no claim is submitted to the Medicare program unless all of the requirements of this policy are met and that no claim is submitted to any other payer unless all of the requirements set forth by that payer are met. Medical Record documentation requirements referenced in the following sections are applicable to all patients regardless of payer.

12 Page 5 of 11 A. Required Preadmission Screening 1. Purpose--a preadmission screening is an evaluation of the patient s condition and need for rehabilitation therapy and medical treatment. The preadmission screening documented in the patient s medical record serves as the primary documentation by the IRF clinical staff of the patient s status prior to admission and of the specific reasons that led to the conclusion that the IRF admission would be reasonable and necessary. 2. Timing of Preadmission Screening--all patients shall receive a preadmission screening that is conducted by licensed or certified clinicians within 48 hours immediately preceding the IRF admission. A preadmission screening that includes all the required elements, but that is conducted more than 48 hours immediately preceding the IRF admission, is acceptable as long as an update to the original screening is conducted in person or by telephone to document the patient s medical and functional status within the 48 hours immediately preceding the IRF admission. The documentation shall be detailed and comprehensive. The review shall be done in person or through a review of the patient s acute care hospital medical record (either paper or electronic), as long as those medical records contain the necessary assessments to make a reasonable determination. A preadmission screening conducted entirely by telephone will not be acceptable without transmission of the patient s medical record from the referring hospital to the IRF and a timely review of those records by licensed or certified clinical staff in the IRF. 3. Documentation--all preadmission screening documentation (including documents transmitted from the referring hospital or other prior inpatient hospital stay) shall be retained in the patient s medical record at the IRF. 4. Licensed or Certified Clinician--referral and preadmission screening documentation shall be completed by licensed/certified clinicians who are permitted to perform assessments within their state scope of practice, have evidence of training and competency to perform preadmission screenings, and be approved by the rehabilitation physician. Individuals, regardless of clinical qualifications, assigned to business development functions such as marketing and community relations will not conduct clinical preadmission screenings for the purpose of determining if the admission criteria are met for the inpatient rehabilitation program. 5. The data collections process may be completed by an assistant (PTA, COTA or LVN/LPN, etc.). The assistant may only perform data collection and chart review activities for the purpose of providing information used by the clinician performing the preadmission screening. The qualified clinician conducting and documenting the preadmission screening shall review and approve any data collected by an assistant. The assistant may not visit with the patient and/or family, perform patient assessments, document on the preadmission screening form, or make recommendations regarding the pre admission assessment.

13 Page 6 of Content the Preadmission screening shall clearly document the following: (a) Indicate the patient s prior level of function (prior to the event or condition that led to the patient s need for intensive rehabilitation therapy). (b) Expected level of improvement and the expected length of time necessary to achieve that level of improvement. (c) An evaluation of the patient s risk for clinical complications. (d) The conditions that caused the need for rehabilitation and the treatments needed (i.e. physical therapy, occupational therapy, speech-language, or prosthetic s/orthotics). (e) Expected frequency and duration of treatment in the IRF. (f) A reasonable expectation that the patient will actively participate in, and benefit significantly from, at least 3 hours of therapy per day at least 5 days per week. (g) A reasonable expectation that a measurable, practical improvement in the patient s functional condition can be accomplished within a pre-determined and reasonable period of time. (h) Anticipated discharge destination and any anticipated post-discharge treatments. 7. Rehabilitation Physician Review For Medicare Part A patients, all findings of the preadmission screening shall be conveyed to a rehabilitation physician prior to the IRF admission. In addition, the rehabilitation physician shall document that he or she has reviewed and concurs with the findings and results of the preadmission screening prior to the IRF admission. (a) Trial Admissions-- Trial IRF admissions, during which patients were sometimes admitted to IRFs for 3 to 10 days to assess whether the patients would benefit significantly from treatment in the IRF setting, are no longer considered reasonable and necessary. B. Post Admission Physician Evaluation 1. A Post Admission evaluation of the patient shall be performed by a rehabilitation physician (with input from the interdisciplinary team) within the first 24 hours of admission to the IRF. The purpose of the post admission physician evaluation is to document the patient s status on admission to the IRF, compare it to that noted in the preadmission screening documentation, and begin the development of the patient s overall plan of care and course of treatment. The post admission physician evaluation shall identify any relevant changes that may have occurred since the preadmission screening and shall include a documented history and physical exam, as well as a review of the patient s prior and current medical and functional conditions and comorbidities.

Inpatient Rehabilitation Facilities (IRFs) [Preauthorization Required]

Inpatient Rehabilitation Facilities (IRFs) [Preauthorization Required] Inpatient Rehabilitation Facilities (IRFs) [Preauthorization Required] Medical Policy: MP-ME-05-09 Original Effective Date: February 18, 2009 Reviewed: April 22, 2011 Revised: This policy applies to products

More information

GENERAL ADMISSION CRITERIA INPATIENT REHABILITATION PROGRAMS

GENERAL ADMISSION CRITERIA INPATIENT REHABILITATION PROGRAMS Originator: Case Management Original Date: 9/94 Review/Revision: 6/96, 2/98, 1/01, 4/02, 8/04, 3/06, 03/10, 3/11, 3/13 Stakeholders: Case Management, Medical Staff, Nursing, Inpatient Therapy GENERAL ADMISSION

More information

Acute Inpatient Rehabilitation Level of Care

Acute Inpatient Rehabilitation Level of Care Printer-Friendly Page Acute Inpatient Rehabilitation Level of Care EFFECTIVE DATE 07/06/2010 LAST UPDATED 07/06/2010 Prospective review is recommended/required. Please check the member agreement for preauthorization

More information

OVERVIEW This policy is to document the criteria for coverage of services at the acute inpatient rehabilitation level of care.

OVERVIEW This policy is to document the criteria for coverage of services at the acute inpatient rehabilitation level of care. Medical Coverage Policy Acute Inpatient Rehabilitation Level of Care EFFECTIVE DATE: 07 06 2010 POLICY LAST UPDATED: 06 04 2013 sad OVERVIEW This policy is to document the criteria for coverage of services

More information

Follow-up information from the November 12 provider training call

Follow-up information from the November 12 provider training call Follow-up information from the November 12 provider training call Criteria I. Multiple Therapy Disciplines 1. Clarification regarding the use of group therapies in IRFs. Answer: CMS has not yet established

More information

Fact Sheet #1 Inpatient Rehabilitation Facility Classification Requirements

Fact Sheet #1 Inpatient Rehabilitation Facility Classification Requirements Fact Sheet #1 Inpatient Rehabilitation Facility Classification Requirements Provider Types Affected All hospitals or units of a hospital that are classified under subpart B of part 412 of the Medicare

More information

West Penn Allegheny Health System

West Penn Allegheny Health System West Penn Allegheny Health System System Compliance Department Medical Necessity and Billing for Inpatient Rehabilitation Lessons Learned from an Inpatient Rehab Unit Billing Audit 2006 HCCA Compliance

More information

Inpatient Rehabilitation Facilities Relief from 75% Compliance Threshold Full Implementation. By: Cherilyn G. Murer, JD, CRA

Inpatient Rehabilitation Facilities Relief from 75% Compliance Threshold Full Implementation. By: Cherilyn G. Murer, JD, CRA Inpatient Rehabilitation Facilities Relief from 75% Compliance Threshold Full Implementation By: Cherilyn G. Murer, JD, CRA Inpatient Rehabilitation Overview Inpatient rehabilitation facilities (IRFs)

More information

1. Clarification regarding whether an admission order must be completed before any therapy evaluations are initiated.

1. Clarification regarding whether an admission order must be completed before any therapy evaluations are initiated. Follow-up information from the November 12 provider training call I. Admission Orders 1. Clarification regarding whether an admission order must be completed before any therapy evaluations are initiated.

More information

Regulatory Compliance Policy No. COMP-RCC 4.20 Title:

Regulatory Compliance Policy No. COMP-RCC 4.20 Title: I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.20 Page: 1 of 11 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2)

More information

PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY / PROCEDURE:

PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY / PROCEDURE: PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY/PROCEDURE Policy Number: MCUP3003 (previously UP100303) Reviewing Entities: Credentialing IQI P & T QUAC Approving Entities: BOARD CEO COMPLIANCE FINANCE PAC

More information

SENATE, No. 368 STATE OF NEW JERSEY. Introduced Pending Technical Review by Legislative Counsel PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION

SENATE, No. 368 STATE OF NEW JERSEY. Introduced Pending Technical Review by Legislative Counsel PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION SENATE, No. STATE OF NEW JERSEY Introduced Pending Technical Review by Legislative Counsel PRE-FILED FOR INTRODUCTION IN THE SESSION By Senators MATHEUSSEN and LYNCH 0 0 AN ACT concerning subacute care

More information

Regulatory Compliance Policy No. COMP-RCC 4.32 Title:

Regulatory Compliance Policy No. COMP-RCC 4.32 Title: I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.32 Page: 1 of 4 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2)

More information

CURRENT AND FUTURE TRENDS IN POST ACUTE CARE The Value and Role of Acute Inpatient Rehab

CURRENT AND FUTURE TRENDS IN POST ACUTE CARE The Value and Role of Acute Inpatient Rehab CURRENT AND FUTURE TRENDS IN POST ACUTE CARE The Value and Role of Acute Inpatient Rehab Robert S. Djergaian, M.D. Medical Director Banner Good Samaritan Rehabilitation Institute Stewardship Profitability

More information

PREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium

PREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium PREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium May 31, 2013 2 DEFINITION: INPATIENT REHABILITATION FACILITY

More information

REHABILITATION SERVICES

REHABILITATION SERVICES REHABILITATION SERVICES Table of Contents GENERAL... 2 TERMS AND ABBREVIATIONS... 2 PRIOR AUTHORIZATION REQUIREMENTS FOR MEDICAID REIMBURSEMENT OF INPATIENT REHABILITATION SERVICES (Updated 4/1/11)...

More information

Guidelines for Medical Necessity Determination for Occupational Therapy

Guidelines for Medical Necessity Determination for Occupational Therapy Guidelines for Medical Necessity Determination for Occupational Therapy These Guidelines for Medical Necessity Determination (Guidelines) identify the clinical information MassHealth needs to determine

More information

Rehabilitation Regulatory Compliance Risks

Rehabilitation Regulatory Compliance Risks Rehabilitation Regulatory Compliance Risks Christine Bachrach Vice President & Chief Compliance Officer University of Maryland Medical System 2011 AHIA Annual Conference Agenda - Rehabilitation Compliance

More information

Law Department Policy No. L-6 Title:

Law Department Policy No. L-6 Title: I. SCOPE: Law Department Policy No. L-6 Page: 1 of 7 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other entity

More information

Regulatory Compliance Policy No. COMP-RCC 4.07 Title:

Regulatory Compliance Policy No. COMP-RCC 4.07 Title: I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.07 Page: 1 of 7 This policy applies to (1) any Hospital in which Tenet Healthcare Corporation or an affiliate owns a direct or indirect equity interest

More information

Good Samaritan Inpatient Rehabilitation Program

Good Samaritan Inpatient Rehabilitation Program Good Samaritan Inpatient Rehabilitation Program Living at your full potential. Welcome When people are sick or injured, our goal is their maximum recovery. We help people live to their full potential.

More information

CENTER OF EXCELLENCE IN REHABILITATION SERVICES. Policies Standards Survey Process

CENTER OF EXCELLENCE IN REHABILITATION SERVICES. Policies Standards Survey Process CENTER OF EXCELLENCE IN REHABILITATION SERVICES Policies Standards Survey Process INTRODUCTION The CIHQ Center of Excellence in Rehabilitation Services program recognizes specialized inpatient rehabilitation

More information

Regulatory Compliance Policy No. COMP-RCC 4.52 Title:

Regulatory Compliance Policy No. COMP-RCC 4.52 Title: I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.52 Page: 1 of 19 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2)

More information

REHAB RULES REVISITED

REHAB RULES REVISITED REHAB RULES REVISITED by CHERILYN G. MURER, J.D., C.R.A. Recent changes in the rules governing inpatient rehabilitation hospitals and units, particularly the implementation of the new prospective payment

More information

Cenpatico STRS POLICIES & PROCEDURES. Effective Date: 07/11/11 Review/Revision Date: 07/11/11, 09/21/11

Cenpatico STRS POLICIES & PROCEDURES. Effective Date: 07/11/11 Review/Revision Date: 07/11/11, 09/21/11 Page 1 of 14 SCOPE: Clinical Department IMPORTANT REMINDER This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough review and consideration

More information

The Rehab Program At Stillwater Medical Center Disclosure Statement January 1 2014 December 31-2014. Patient Name.

The Rehab Program At Stillwater Medical Center Disclosure Statement January 1 2014 December 31-2014. Patient Name. Patient Name Mission Statement The mission of Stillwater Medical Center/ Rehab Center is: to provide an intensive, interdisciplinary rehabilitation program of the highest quality that will result in the

More information

Stakeholder s Report. 2525 SW 75 th Ave Miami, Florida 33155 305.262.6800 www.westgablesrehabhospital.com

Stakeholder s Report. 2525 SW 75 th Ave Miami, Florida 33155 305.262.6800 www.westgablesrehabhospital.com 212 Stakeholder s Report 2525 SW 75 th Ave Miami, Florida 33155 35.262.68 www.westgablesrehabhospital.com PROFILE REPORT For more than 25 years, West Gables Rehabilitation Hospital has made a mission of

More information

OVERVIEW OF LONG TERM CARE HOSPITALS AND INPATIENT REHABILITATION FACILITIES AND THEIR ROLE IN THE POST ACUTE CARE CONTINUUM

OVERVIEW OF LONG TERM CARE HOSPITALS AND INPATIENT REHABILITATION FACILITIES AND THEIR ROLE IN THE POST ACUTE CARE CONTINUUM OVERVIEW OF LONG TERM CARE HOSPITALS AND INPATIENT REHABILITATION FACILITIES AND THEIR ROLE IN THE POST ACUTE CARE CONTINUUM I. INTRODUCTION Government regulation of Medicare providers continues as a means

More information

NORWALK HOSPITAL DID NOT COMPLY WITH MEDICARE INPATIENT REHABILITATION FACILITY DOCUMENTATION REQUIREMENTS

NORWALK HOSPITAL DID NOT COMPLY WITH MEDICARE INPATIENT REHABILITATION FACILITY DOCUMENTATION REQUIREMENTS Department of Health and Human Services OFFICE OF INSPECTOR GENERAL NORWALK HOSPITAL DID NOT COMPLY WITH MEDICARE INPATIENT REHABILITATION FACILITY DOCUMENTATION REQUIREMENTS Inquiries about this report

More information

Rehabilitation Reimbursement Update By: Cherilyn G. Murer, JD, CRA

Rehabilitation Reimbursement Update By: Cherilyn G. Murer, JD, CRA Rehabilitation Reimbursement Update By: Cherilyn G. Murer, JD, CRA Introduction The Centers for Medicare & Medicaid Services (CMS) and legislators in this country remain dedicated to ensuring that beneficiaries

More information

10-144 Chapter 101 MAINECARE BENEFITS MANUAL CHAPTER II SECTION 68 OCCUPATIONAL THERAPY SERVICES ESTABLISHED 9/1/87 LAST UPDATED 1/1/14

10-144 Chapter 101 MAINECARE BENEFITS MANUAL CHAPTER II SECTION 68 OCCUPATIONAL THERAPY SERVICES ESTABLISHED 9/1/87 LAST UPDATED 1/1/14 MAINECARE BENEFITS MANUAL TABLE OF CONTENTS 68.01 PURPOSE... 1 PAGE 68.02 DEFINITIONS... 1 68.02-1 Functionally Significant Improvement... 1 68.02-2 Long-Term Chronic Pain... 1 68.02-3 Maintenance Care...

More information

CHAPTER 6 COMPREHENSIVE MEDICAL REHABILITATION SERVICES

CHAPTER 6 COMPREHENSIVE MEDICAL REHABILITATION SERVICES CHAPTER 6 COMPREHENSIVE MEDICAL REHABILITATION SERVICES . Chapter 6 Comprehensive Medical Rehabilitation Services 100 Comprehensive Medical Rehabilitation Services Comprehensive medical rehabilitation

More information

Chapter 17. Medicaid Provider Manual

Chapter 17. Medicaid Provider Manual Chapter 17 Medicaid Provider Manual February 2011 TABLE OF CONTENTS 17.1 Occupational Therapy... 1 17.1.1 Description... 1 17.1.2 Amount, Duration and Scope... 1 17.1.3 Exclusions... 1 17.1.4 Limitations...

More information

Complex Continuing Care Restorative Care (Combined Functional Enhancement and Restorative Care Programs)

Complex Continuing Care Restorative Care (Combined Functional Enhancement and Restorative Care Programs) Complex Continuing Care Restorative Care (Combined Functional Enhancement and Restorative Care Programs) Description: The Restorative Care program provides a moderate to low intensity goal-oriented rehabilitation

More information

Regulatory Compliance Policy No. COMP-RCC 4.25 Title:

Regulatory Compliance Policy No. COMP-RCC 4.25 Title: I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.25 Title: HOSPITAL COVERAGE NOTICES FOR MEDICARE INPATIENTS (INCLUDING IMPORTANT MESSAGE FROM MEDICARE) Page: 1 of 16 Effective Date: 03-19-15 Retires

More information

Law Department Policy No. L-7 Title:

Law Department Policy No. L-7 Title: I. SCOPE: Law Department Policy No. L-7 Page: 1 of 11 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other entity

More information

Law Department Policy No. L-3 Title:

Law Department Policy No. L-3 Title: I. SCOPE: Law Department Policy No. L-3 Page: 1 of 15 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other entity

More information

GAO MEDICARE. More Specific Criteria Needed to Classify Inpatient Rehabilitation Facilities

GAO MEDICARE. More Specific Criteria Needed to Classify Inpatient Rehabilitation Facilities GAO United States Government Accountability Office Report to the Senate Committee on Finance and the House Committee on Ways and Means April 2005 MEDICARE More Specific Criteria Needed to Classify Inpatient

More information

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES Version 2015-1 Page 1 of 11 Table of Contents SECTION I REQUIREMENTS FOR PARTICIPATION IN MEDICAID 3 QUALIFIED PRACTITIONERS. 3

More information

MEDICAL POLICY POLICY TITLE POLICY NUMBER ACUTE INPATIENT REHABILITATION MP-8.003

MEDICAL POLICY POLICY TITLE POLICY NUMBER ACUTE INPATIENT REHABILITATION MP-8.003 Original Issue Date (Created): July 1, 2002 Most Recent Review Date (Revised): Effective Date: May 27, 2008 May 1, 2008- RETIRED I. DESCRIPTION/BACKGROUND Inpatient rehabilitation hospitals provide an

More information

SAM KARAS ACUTE REHABILITATION CENTER

SAM KARAS ACUTE REHABILITATION CENTER SAM KARAS ACUTE REHABILITATION CENTER 1 MEDICAL CARE Sam Karas Acute Rehabilitation The Sam Karas Acute Rehabilitation Center is a comprehensive and interdisciplinary inpatient unit. Medical care is directed

More information

Rehabilitation Nursing Criteria for Determination and Documentation of Medical Necessity in an Inpatient Rehabilitation Facility

Rehabilitation Nursing Criteria for Determination and Documentation of Medical Necessity in an Inpatient Rehabilitation Facility Rehabilitation Nursing Criteria for Determination and Documentation of Medical Necessity in an Inpatient Rehabilitation Facility An ARN Position Statement The objective of this Position Statement is to

More information

Transmittal 55 Date: MAY 5, 2006. SUBJECT: Changes Conforming to CR3648 for Therapy Services

Transmittal 55 Date: MAY 5, 2006. SUBJECT: Changes Conforming to CR3648 for Therapy Services CMS Manual System Pub 100-03 Medicare National Coverage Determinations Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 55 Date: MAY 5, 2006 Change

More information

Regulatory Compliance Policy No. COMP-RCC 4.03 Title:

Regulatory Compliance Policy No. COMP-RCC 4.03 Title: I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.03 Page: 1 of 10 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2)

More information

Clinical Coverage Criteria Extended Care Facility

Clinical Coverage Criteria Extended Care Facility Clinical Coverage Criteria Extended Care Facility Document Number: 018 Commercial MassHealth* Commonwealth Care Authorization required X X X Notification within 24 hours of service or next business day

More information

Pathology and Audiology Services and Occupational and Physical Therapies

Pathology and Audiology Services and Occupational and Physical Therapies 3 O0100 O-1 Do not code services that were provided solely in conjunction with a surgical procedure or diagnostic procedure, such as IV medications or ventilators. Surgical procedures include routine pre-

More information

Hospital Discharge Planning: Advocating for Seniors Medicare Rehabilitation Benefits

Hospital Discharge Planning: Advocating for Seniors Medicare Rehabilitation Benefits Chapter 22 Hospital Discharge Planning: Advocating for Seniors Medicare Rehabilitation Benefits Michele M. Lawonn, Esq., P.T., C.A.P.S. Medical-Legal Advocates, LLC SYNOPSIS 22-1. Discharge Planning 22-2.

More information

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated

More information

Inpatient rehabilitation facility services

Inpatient rehabilitation facility services Inpatient rehabilitation facility services C H A P T E R9 R E C O M M E N D A T I O N 9 The Congress should eliminate the update to the Medicare payment rates for inpatient rehabilitation facilities in

More information

REHABILITATION UNIT CRITERIA WORK SHEET

REHABILITATION UNIT CRITERIA WORK SHEET DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED OMB NO. 0938-0986 REHABILITATION UNIT CRITERIA WORK SHEET RELATED MEDICARE PROVIDER NUMBER ROOM NUMBERS IN

More information

Government Programs Policy No. GP - 6 Title:

Government Programs Policy No. GP - 6 Title: I. SCOPE: Government Programs Policy No. GP - 6 Page: 1 of 12 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other

More information

Project Plan to Rehabilitation Service

Project Plan to Rehabilitation Service Project Plan to Rehabilitation Service Connecting and Collaborating in the Continuity of Care in Rehabilitation Presented By: Arlene Whitehead, May 31, 2011 Rehabilitation Collaborative Overview OUTLINE

More information

T H E P A T H W A Y T O I N D E P E N D E N C E

T H E P A T H W A Y T O I N D E P E N D E N C E Bryant T. Aldridge Rehabilitation Center T H E P A T H W A Y T O I N D E P E N D E N C E Therapeutic Garden The road to recovery can be full of obstacles. Life-changing illnesses or accidents such as traumatic

More information

RE: CMS-1608-P; Medicare Program Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2015

RE: CMS-1608-P; Medicare Program Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2015 June 27, 2014 Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1608-P Room 445-G, Hubert Humphrey Building 200 Independence

More information

PSYCHIATRIC UNIT CRITERIA WORK SHEET

PSYCHIATRIC UNIT CRITERIA WORK SHEET DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES PSYCHIATRIC UNIT CRITERIA WORK SHEET RELATED MEDICARE PROVIDER NUMBER ROOM NUMBERS IN THE UNIT FACILITY NAME AND ADDRESS

More information

T- 09 Up Up and Away with Mediocre Therapy Documentation

T- 09 Up Up and Away with Mediocre Therapy Documentation T- 09 Up Up and Away with Mediocre Therapy Documentation Carol Ashdown M. A. CCC-SLP RAC-CT CHC Carol Ashdown is a Regional Vice President of Consulting for Exponential Consulting Services specializing

More information

Guidelines for the Operation of Burn Centers

Guidelines for the Operation of Burn Centers C h a p t e r 1 4 Guidelines for the Operation of Burn Centers............................................................. Each year in the United States, burn injuries result in more than 500,000 hospital

More information

Inpatient rehabilitation facility services

Inpatient rehabilitation facility services C h a p t e r10 Inpatient rehabilitation facility services R E C O M M E N D A T I O N 10 The Congress should eliminate the update to the Medicare payment rates for inpatient rehabilitation facilities

More information

Reviewing Hospital Claims for Patient Status: Admissions On or After October 1, 2013 (Last Updated: 11/27/13)

Reviewing Hospital Claims for Patient Status: Admissions On or After October 1, 2013 (Last Updated: 11/27/13) Reviewing Hospital Claims for Patient Status: Admissions On or After October 1, 2013 (Last Updated: 11/27/13) Medical Review of Inpatient Hospital Claims CMS plans to issue guidance to Medicare Administrative

More information

4. PROGRAM REQUIREMENTS

4. PROGRAM REQUIREMENTS TABLE OF CONTENTS iv 4. PROGRAM REQUIREMENTS 413.401: Introduction... 4-1 413.402: Definitions... 4-1 413.403: Eligible Members... 4-3 413.404: Provider Eligibility... 4-3 413.405: Services Provided by

More information

TITLE: Processing Provider Orders: Inpatient and Outpatient

TITLE: Processing Provider Orders: Inpatient and Outpatient POLICY and PROCEDURE TITLE: Processing Provider Orders: Inpatient and Outpatient Number: 13211 Version: 13211.3 Type: Patient Care Author: Janice Dinner; Provider Order Policy Committee Effective Date:

More information

National Stroke Association s Guide to Choosing Stroke Rehabilitation Services

National Stroke Association s Guide to Choosing Stroke Rehabilitation Services National Stroke Association s Guide to Choosing Stroke Rehabilitation Services Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Through rehab, you: Re-learn basic skills

More information

Patient s Handbook. Provincial Rehabilitation Unit ONE ISLAND HEALTH SYSTEM ONE ISLAND FUTURE 11HPE41-30364

Patient s Handbook. Provincial Rehabilitation Unit ONE ISLAND HEALTH SYSTEM ONE ISLAND FUTURE 11HPE41-30364 Patient s Handbook Provincial Rehabilitation Unit ONE ISLAND FUTURE ONE ISLAND HEALTH SYSTEM 11HPE41-30364 REHABILITATION EQUIPMENT USED ON UNIT 7 During a patient s stay on Unit 7, various pieces of

More information

Inpatient Rehabilitation Facility (IRF) Services. Part A Provider Outreach and Education September 2015

Inpatient Rehabilitation Facility (IRF) Services. Part A Provider Outreach and Education September 2015 Inpatient Rehabilitation Facility (IRF) Services Part A Provider Outreach and Education September 2015 DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC. It may

More information

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 21 MENTAL HYGIENE REGULATIONS Chapter 26 Community Mental Health Programs Residential Crisis Services Authority: Health-General Article, 10-901

More information

SCOPE OF SERVICES ORLANDO HEALTH REHABILITATION INSTITUTE: 2013-2014

SCOPE OF SERVICES ORLANDO HEALTH REHABILITATION INSTITUTE: 2013-2014 MISSION STATEMENT / PHILOSOPHY The mission of Orlando Health and Orlando Health Rehabilitation Institute (OHRI) is to improve the health and quality of life of the individuals and communities we serve.

More information

907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies.

907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies. 907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies. RELATES TO: KRS 205.520, 216B.450, 216B.455, 216B.459 STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1),

More information

Law Department Policy No. L-4 Title:

Law Department Policy No. L-4 Title: I. SCOPE: Law Department Policy No. L-4 Page: 1 of 10 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other entity

More information

Rehabilitation Hospital I Lutheran Medical Park 7970 W. Jefferson Blvd. I Fort Wayne, IN 46804

Rehabilitation Hospital I Lutheran Medical Park 7970 W. Jefferson Blvd. I Fort Wayne, IN 46804 Rehabilitation Hospital I Lutheran Medical Park 7970 W. Jefferson Blvd. I Fort Wayne, IN 46804 Admissions: (260) 435-6121 I Switchboard: (260) 435-6100 LutheranHealth.net Lutheran Health Network includes

More information

MEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT

MEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT Summary of Changes MEDICAL POLICY MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD ADOLESCENT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 14, 2014 Status: Current Clarifications:

More information

Subacute Inpatient MH - Adult

Subacute Inpatient MH - Adult Subacute Inpatient MH - Adult Definition Subacute Inpatient hospital psychiatric services are medically necessary short-term psychiatric services provided to a client with a primary psychiatric diagnosis

More information

Appendix B NMMCP Covered Services and Exceptions

Appendix B NMMCP Covered Services and Exceptions Acute Inpatient Hospitalization MH - Adult Definition An Acute Inpatient program is designed to provide medically necessary, intensive assessment, psychiatric treatment and support to individuals with

More information

Inpatient rehabilitation facility services

Inpatient rehabilitation facility services C h a p t e r10 Inpatient rehabilitation facility services R E C O M M E N D A T I O N 10 The Congress should eliminate the update to the Medicare payment rates for inpatient rehabilitation facilities

More information

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, postpolio syndrome, rheumatoid arthritis, lupus

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, postpolio syndrome, rheumatoid arthritis, lupus TIRR Memorial Hermann is a nationally recognized rehabilitation hospital that returns lives interrupted by neurological illness, trauma or other debilitating conditions back to independence. Some of the

More information

410-127-0020 Definitions... 1. 410-127-0040 Coverage... 5. 410-127-0050 Client Copayments... 6. 410-127-0060 Reimbursement and Limitations...

410-127-0020 Definitions... 1. 410-127-0040 Coverage... 5. 410-127-0050 Client Copayments... 6. 410-127-0060 Reimbursement and Limitations... Home Health Services Administrative Rulebook Division of Medical Assistance Programs Policy and Planning Section Table of Contents Chapter 410, Division 127 Effective January 1, 2014 410-127-0020 Definitions...

More information

MEDICAID GUIDELINES FOR HOME HEALTH THERAPY SERVICES (PHYSICAL, OCCUPATIONAL & SPEECH THERAPY)

MEDICAID GUIDELINES FOR HOME HEALTH THERAPY SERVICES (PHYSICAL, OCCUPATIONAL & SPEECH THERAPY) MEDICAID GUIDELINES FOR HOME HEALTH THERAPY SERVICES (PHYSICAL, OCCUPATIONAL & SPEECH THERAPY) I. General Principles Governing Reasonable and Necessary Physical Therapy, Speech Therapy and Occupational

More information

DOCUMENTATION IN PHYSICAL THERAPY PRACTICE LEARNING OBJECTIVES

DOCUMENTATION IN PHYSICAL THERAPY PRACTICE LEARNING OBJECTIVES DOCUMENTATION IN PHYSICAL THERAPY PRACTICE LEARNING OBJECTIVES 1. Describe typical challenges therapists have in clinical documentation and identify activities to facilitate efficient and effective documentation

More information

Inpatient or Outpatient Only: Why Observation Has Lost Its Status

Inpatient or Outpatient Only: Why Observation Has Lost Its Status Inpatient or Outpatient Only: Why Observation Has Lost Its Status W h i t e p a p e r Proper patient status classification affects the clinical and financial success of hospitals. Unfortunately, assigning

More information

CHAPTER 37H. YOUTH CASE MANAGEMENT SERVICES SUBCHAPTER 1. GENERAL PROVISIONS Expires December 2, 2013

CHAPTER 37H. YOUTH CASE MANAGEMENT SERVICES SUBCHAPTER 1. GENERAL PROVISIONS Expires December 2, 2013 CHAPTER 37H. YOUTH CASE MANAGEMENT SERVICES SUBCHAPTER 1. GENERAL PROVISIONS Expires December 2, 2013 10:37H-1.1 Purpose and scope The rules in this chapter govern the provision of case management services

More information

2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA

2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA 2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA Overview Psychcare strives to provide quality care in the least restrictive environment. An

More information

REHABILITATION. begins right here

REHABILITATION. begins right here REHABILITATION begins right here Select Rehabilitation Hospital of Denton offers you a new direction in medical rehabilitation. Our 44-bed, state-of-the-science hospital offers unparalleled treatment to

More information

Rehabilitation Where You Recover. Inpatient Rehabilitation Services at Albany Medical Center

Rehabilitation Where You Recover. Inpatient Rehabilitation Services at Albany Medical Center Rehabilitation Where You Recover Inpatient Rehabilitation Services at Albany Medical Center You're Here and So Are We As the region s only academic medical center, Albany Medical Center offers a number

More information

ISSUED BY: TITLE: ISSUED BY: TITLE: President

ISSUED BY: TITLE: ISSUED BY: TITLE: President CLINICAL PRACTICE GUIDELINE PROFESSIONAL PRACTICE TITLE: Stroke Care Rehabilitation Unit DATE OF ISSUE: 2005, 05 PAGE 1 OF 7 NUMBER: CPG 20-3 SUPERCEDES: New ISSUED BY: TITLE: Chief of Medical Staff ISSUED

More information

Section 6. Medical Management Program

Section 6. Medical Management Program Section 6. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.

More information

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, postpolio syndrome, rheumatoid arthritis, lupus

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, postpolio syndrome, rheumatoid arthritis, lupus TIRR Memorial Hermann is a nationally recognized rehabilitation hospital that returns lives interrupted by neurological illness, trauma or other debilitating conditions back to independence. Some of the

More information

Resident will learn independently in addition to scheduled didactics. Learning is centered on the 7 core competencies as follows:

Resident will learn independently in addition to scheduled didactics. Learning is centered on the 7 core competencies as follows: Educational Goals & Objectives Physical and Occupational Therapies are an important part of patient care. The Physical Therapy rotation, under the supervision of the Director of Rehabilitation, is a one

More information

Regulatory Compliance Policy No. COMP-RCC 4.17 Title:

Regulatory Compliance Policy No. COMP-RCC 4.17 Title: I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.17 Page: 1 of 6 This Policy applies to (1) Tenet Healthcare Corporation and its wholly owned subsidiaries and affiliates (each, an Affiliate ); (2)

More information

THE INPATIENT REHABILITATION FACILITY PATIENT ASSESSMENT INSTRUMENT (IRF-PAI) TRAINING MANUAL:

THE INPATIENT REHABILITATION FACILITY PATIENT ASSESSMENT INSTRUMENT (IRF-PAI) TRAINING MANUAL: THE INPATIENT REHABILITATION FACILITY PATIENT ASSESSMENT INSTRUMENT (IRF-PAI) TRAINING MANUAL: EFFECTIVE 10/01/2012 For patient assessments performed when a patient is discharged on or after October 1,

More information

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, post-polio syndrome, rheumatoid arthritis, lupus

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, post-polio syndrome, rheumatoid arthritis, lupus TIRR Memorial Hermann is a nationally recognized rehabilitation hospital that returns lives interrupted by neurological illness, trauma or other debilitating conditions back to independence. Some of the

More information

Reviewing Hospital Claims for Inpatient Status: The 2-Midnight Benchmark

Reviewing Hospital Claims for Inpatient Status: The 2-Midnight Benchmark Reviewing Hospital Claims for Patient Status: Admissions On or After October 1, 2013 (Last Updated: 03/12/14) Medical Review of Inpatient Hospital Claims CMS plans to issue guidance to Medicare Administrative

More information

Guidelines for Medical Necessity Determination for Speech and Language Therapy

Guidelines for Medical Necessity Determination for Speech and Language Therapy Guidelines for Medical Necessity Determination for Speech and Language Therapy These Guidelines for Medical Necessity Determination (Guidelines) identify the clinical information MassHealth needs to determine

More information

Acute Rehabilitation Center

Acute Rehabilitation Center Acute Rehabilitation Center Acute Rehabilitation Courtyard Our Center Community Westview Hospital's Acute Rehabilitation Center and programs are specially designed to meet the needs of our patients and

More information

Dedicated Stroke Interprofessional Rehab Team. Mixed Rehab Unit. Dedicated Rehab Unit

Dedicated Stroke Interprofessional Rehab Team. Mixed Rehab Unit. Dedicated Rehab Unit Outpatient & Community I n p a t I e n t Stroke Rehab Definition Framework Institutional Setting Inpatient Rehab in Acute Care or Rehab Hospitals* Acute Care Integrated Specialized Units Transitional Care

More information

Inpatient rehabilitation facility services

Inpatient rehabilitation facility services C h a p t e r10 Inpatient rehabilitation facility services R E C O M M E N D A T I O N 10 The Congress should eliminate the update to the Medicare payment rates for inpatient rehabilitation facilities

More information

Deciphering the Details:

Deciphering the Details: Deciphering the Details: An update on implementing PPS for inpatient rehabilitation facilities. By: Cherilyn G. Murer, J.D., C.R.A. President & CEO - The Murer Group Reimbursement for operating costs of

More information

Profile: Kessler Patients

Profile: Kessler Patients Profile: Kessler Patients 65 Breakthrough Years Kessler Institute has pioneered the course of medical rehabilitation since 1948. Today, as the nation s largest single rehabilitation hospital, we continue

More information

Level of Care Tip Sheet MANAGING CONTINUOUS HOME CARE FOR SYMPTOM MANAGEMENT TIPS FOR PROVIDERS WHAT IS CONTINUOUS HOME CARE?

Level of Care Tip Sheet MANAGING CONTINUOUS HOME CARE FOR SYMPTOM MANAGEMENT TIPS FOR PROVIDERS WHAT IS CONTINUOUS HOME CARE? Level of Care Tip Sheet National Hospice and Palliative Care Organization www.nhpco.org/regulatory MANAGING CONTINUOUS HOME CARE FOR SYMPTOM MANAGEMENT WHAT IS CONTINUOUS HOME CARE? TIPS FOR PROVIDERS

More information

Patient Information Guide. Getting you Back to Better. 859.426.2400 www.vrhgateway.com

Patient Information Guide. Getting you Back to Better. 859.426.2400 www.vrhgateway.com Patient Information Guide Getting you Back to Better 859.426.2400 www.vrhgateway.com The Gateway Difference Gateway Rehabilitation Hospital provides expert care to help patients get back to better after

More information

Medical Policy Extended Care Facility

Medical Policy Extended Care Facility Medical Policy Extended Care Facility Document Number: 018 Commercial and MassHealth* Connector/Qualified Health Plans Authorization required X X Notification within 24 hours of service or next business

More information